DR. STEPHAN KERMIT WOODMAN (NPI# 1285662825) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285662825 |
| Entity Type | Individual |
| Full Name | DR. STEPHAN KERMIT WOODMAN |
| Credential | M.D. |
| Practice Address |
2620 W Faidley Ave Grand Island NE 68803-4205 |
| Mailing Address |
2808 Old Fair Rd Grand Island NE 68803-5220 |
| Practice Telephone | 3083826856 |
| Practice Fax Number | 3083811560 |
| Mailing Telephone | 3083826856 |
| Mailing Fax Number | 3083811560 |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
36619 | IA | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
0430987 | KS | Allopathic & Osteopathic Physicians |
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
12780 | NE | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | DEA | AW2370980 | 01 |
| NE | BLUE CROSS BLUE SHIELD | 00422 | 01 |
| Street Address |
2620 W FAIDLEY AVE |
| City | GRAND ISLAND |
| State | NE |
| Zip Code | 68803-4205 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194701276 | Susan Elaine Beaty | Registered Nurse | 2620 W Faidley Ave, Wound Ostomy Healing Center, Grand Island, NE 68803-4205 | 2005-12-20 |
| 1780200139 | Emily Rae Christensen | Nurse Practitioner | 2620 W Faidley Ave, Grand Island, NE 68803-4205 | 2020-06-22 |
| 1720621121 | Rachel James | Nurse Practitioner | 2620 W Faidley Ave, Grand Island, NE 68803-4205 | 2019-10-18 |
| 1245724137 | Suellen Ranee Bruguera | Nurse Practitioner | 2620 W Faidley Ave, Grand Island, NE 68803-4205 | 2018-06-14 |
| 1508357930 | Midwest Emergency Grand Island Inc | Emergency Medicine | 2620 W Faidley Ave, Grand Island, NE 68803-4205 | 2018-05-22 |
| 1740782770 | Lpp of Nebraska LLC | Emergency Medicine | 2620 W Faidley Ave, Grand Island, NE 68803-4205 | 2018-03-06 |
| 1528588357 | Chelsea Mae Pedroza | Nurse Practitioner | 2620 W Faidley Ave, Grand Island, NE 68803-4205 | 2017-06-22 |
| 1477009686 | Zeeshan Khalid | Internal Medicine | 2620 W Faidley Ave, Grand Island, NE 68803 | 2016-08-28 |
| 1902251010 | Shoaib Junejo | Internal Medicine | 2620 W Faidley Ave, Grand Island, NE 68803-4205 | 2016-04-26 |
| 1730593823 | Suresh Manapuram | Internal Medicine | 2620 W Faidley Ave, Dept of Hospital Medicine, Grand Island, NE 68803 | 2014-06-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467053884 | Christopher Patrin | Counselor | 1811 West 2nd Street, Suite 450, Grand Island, NE 68803 | 2020-11-03 |
| 1942848593 | Specialized Outpatient Services | Counselor | 1811 West 2nd Street Suite 450, Grand Island, NE 68803 | 2019-12-13 |
| 1558910604 | Grand Island Regional Medical Center | General Acute Care Hospital | 3533 Prairieview Street, Grand Island, NE 68803 | 2019-09-10 |
| 1992225817 | Destiny Mostek | Dietitian, Registered | 2201 N. Broadwell Ave, Grand Island, NE 68803 | 2017-06-21 |
| 1184150591 | Brandy Rae Bird | Registered Nurse | Mosaic Msu 2905 West 5th Street, Grand Island, NE 68803 | 2017-05-04 |
| 1831633171 | Karla Jean Sextro | Counselor | 2112 W. Faidley Ave, Grand Island, NE 68803 | 2016-12-06 |
| 1689062895 | Good Hands Clinic PC | Specialist | 524 South Webb Rd, Suite 1, Grand Island, NE 68803 | 2014-12-23 |
| 1346664554 | Lindsey M Modlin | Dental Hygienist | 4234 New York Ave, Grandi Island, NE 68803 | 2014-02-07 |
| 1568711711 | Danessa Marie Kenney | Counselor | 908 N. Howard Ave. Suite 107, Nebraska Children's Home Society, Grand Island, NE 68803 | 2012-09-04 |
| 1649528563 | Nicole Morris | Physical Therapist | 2116 Faidley Ave, Grand Island, NE 68803 | 2012-08-27 |
| Find all providers in zip 68803 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134165509 | Daniel Eugene Novinski | Radiology | 3610 Richmond Cir Ste 100, Grand Island, NE 68803-3910 | 2006-06-22 |
| 1427094341 | Grand Island Imaging Center LLC | Radiology | 3610 Richmond Cir Ste 110, Grand Island, NE 68803-3910 | 2006-06-20 |
| 1871573956 | John Louis Allen | Radiology | 730 N Diers Ave, Grand Island, NE 68803-4954 | 2006-01-17 |
| 1578707113 | Cody L Evans | Radiology | 3610 Richmond Cir Ste 100, Grand Island, NE 68803-3910 | 2009-04-27 |
| 1861682643 | Marcus S Kirkpatrick | Radiology | 3610 Richmond Cir Ste 100, Grand Island, NE 68803-3910 | 2007-07-27 |
| 1053344861 | Tamara Sue Hlavaty | Radiology | 3610 Richmond Cir Ste 100, Grand Island, NE 68803-3910 | 2006-07-08 |
| 1346279973 | Max Andrew Stevens | Radiology | 2620 W Faidley Ave, Grand Island, NE 68803-4205 | 2006-07-03 |
| 1932137593 | Heartland Imaging Specialists LLC | Radiology | 3610 Richmond Cir, Grand Island, NE 68803-3927 | 2006-06-30 |
| 1467480657 | William Robert Marsh | Radiology | 3610 Richmond Cir Ste 100, Grand Island, NE 68803-3910 | 2006-06-28 |
| 1548298748 | Gerald Dwain Janulewicz | Radiology | 2620 W Faidley Ave, Grand Island, NE 68803-4205 | 2006-06-28 |
| Find all providers in GRAND ISLAND | ||||
| City | GRAND ISLAND |
| Zip Code | 68803 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.